This post is my first to be included in Motherwear's Carnival of Breastfeeding. What's a Carnival?  It's a web event in which several bloggers write on a theme, and the posts are assembled in one place. Motherwear has been hosting this event for four years and I'm so happy to be a part of it.

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The theme this month is Birth and Breastfeeding and you can check out the other posts in the carnival at the end. The links will be updated throughout the day on October 25, 2010.

If you decide that you want to breastfeed your baby there are a lot of things that you can do to make sure that you get a good start. Choices that you make when you are pregnant about what kind of birth you want can impact breastfeeding. Decisions made during labor and immediately after birth can influence how easy or difficult breastfeeding might be. Education and determination can go a long way. It's true that sometimes breastfeeding just doesn't work, we can't always control what kind of birth we have and medical situations or personal feelings may arise that we did not anticipate, but hopefully with good support and lots of information, we can begin breastfeeding without too many difficulties and continue as long as possible.

I had a natural hospital birth with my first and a natural home birth with my second and I had a relatively easy time establishing breastfeeding and continuing that relationship for more than 20 months with each of my babies. I also know mothers who had a medicated c-section and had a long breastfeeding relationship with their babies, but they were often faced with challenging circumstances. No matter what kind of birth you have, you can create a strong nursing relationship, but the more natural the birth and the fewer things that come between the mother and the baby, the easier it will be to establish nursing.

Before Labor

  • Hire a doula: My doula gave me pages and pages of invaluable information about nursing and labor and delivery. She also stayed with me in the recovery room until my baby had a successful nursing session. Alternately you can attend a La Leche League meeting to establish a connection with women who can provide nursing support after birth.
  • Take a natural childbirth class: I studied Bradley Method Childbirth and Hypnobirthing and learned many amazing techniques for pain management without drugs. I was able to have a medication free birth and both myself and my baby were alert and completely clear headed so that those first hours after birth were spent together establishing breastfeeding. A natural childbirth will provide mothers with an optimal situation to start breastfeeding. C-sections can cause many issues like respiratory problems in the baby which can impede breastfeeding, a hangover in both mother and baby from medications that make them less inclined or even unable to begin breastfeeding immediately and trauma from the surgery can make anything more difficult.
  • Research birth attendants and birth location to ensure that there is the lowest chance of interventions and a c-section: My first choice hospital had a very high c-section rate, so I switched to a midwife who birthed at a different hospital for my first child and I choose a home birth for our second child. Interventions (like inductions, pitocin, breaking of waters) can interrupt the natural flow of labor, they can cause all kinds of unintended problems and they can often lead to a c-section. Interventions come between the mother and baby, complicate birth and make things harder when you are trying to establish nursing.

During Labor

  • Try to avoid IV fluids and antibiotics: IV fluids can cause over-hydration and edema in the breasts. It is speculated that this prevents the milk from coming in. Antibiotics can cause thrush in your breasts, which makes nursing very painful. In some cases these are both required or necessary and receiving them does not mean that you won't be able to nurse your baby. Drink lots of water and stay hydrated during labor and if an IV is required by the hospital ask if you can get a heparin lock instead. If antibiotics are required for something like Group B strep, take a probiotic with the antibiotic to restore the good bacteria in your system. If you test positive for Group B Strep during pregnancy, talk to your practitioner about ways to deal with it naturally and get retested before you go into labor.

  • Try not to get an epidural for pain or pitocin to speed up labor: During my first labor I had a code word for an epidural that was so difficult to say that I would really have had to make an effort to say it. I didn't need it because I was able to deal with the pain in natural ways like freedom of movement, water, meditation and vocalization. An epidural can slow labor down, and then you will need pitocin. If you get pitocin, labor might hurt so much you will need an epidural. Both of these drugs are sometimes the beginning of a cascade of interventions that can lead to c-sections and sleepy babies that won't nurse. Of course, if an epidural and pitocin are required or desired, don't sweat it, these medications will not make or break your nursing efforts, it's just that they can sometimes lead to other issues.
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After Labor

  • Skin-to-skin contact for mother and baby immediately after birth: I had my baby placed on my stomach for skin-to-skin contact immediately after birth. He naturally began to try to nurse within the first hour. Baby doesn't need a bath right away, doesn't need to be weighed right away and doesn't need to be swaddled until after they have had that first successful nursing session. Skin-to-skin will facilitate the first nursing session and will regulate the baby's temperature.
  • Rooming in: I kept my baby in my room with me at all times. He slept and nursed in my arms and we napped together in bed. The nurses came to our room to weigh him hours after he was born. You need your baby with you to nurse as often as you can.
  • Frequent nursing: I nursed constantly in those first days after my babies were born. Every time my newborn made a peep, I fed him. I was nursing every 20 minutes for a few days. This helps the milk to come in quickly and it establishes a good supply right from the start.
  • Seek guidance and help immediately: I utilized the lactation consultants at the hospital, getting them to show me how to get a good latch within 12 hours of birth. If your breasts and nipples are sore, uncomfortable or they hurt, ask for help right away, do not wait even a day. Ask lots of questions. It's easier to fix little issues before they turn into bigger problems. For my second birth, I called a lactation consultant to come to the house in the first week to give me some guidance. Despite the fact that I had nursed my first for 20 months, my second was a different baby and we had issues that I didn't have with my first.

Once Nursing is Established

  • Continue to try to avoid antibiotics: Antibiotics can cause thrush, which can make it very painful to nurse. Deal with things like plugged ducts and mastitis immediately and in a natural way (cabbage compresses, massage, heat and anti-inflammitories) so that it will not turn into a painful infection. If an infection does develop and antibiotics are required, a probiotic can be taken to restore the good bacteria and prevent thrush. I took an antibiotic while I was nursing for mastistis. My midwife advised me to take a probiotic and I did not develop thrush.
  • Nurse on demand and throughout the night: I always nursed my babies when they cried or woke up. It was the first thing I would do when they were upset or whenever they indicated they wanted to, even if they weren't yet crying. On demand feeding will ensure that your baby is getting all the milk that they need. You can't nurse too often, but you can nurse too little. Newborns will do a head bob looking for the breast, older babies will make a "na na na" sound and toddlers will just ask! When my babies would wake up at night, I would nurse them. Night nursing was the quickest and easiest way for us all to get back to sleep. As soon as you start to withhold nursing, you are weaning them. If you need to skip a regular nursing, pump to keep up your supply.
  • Co-sleep: My babies loved to nurse at night and the only way that I was able to get any sleep some nights was by co-sleeping. I was able to nurse laying down, often just barely waking up and sometimes not waking up at all. If you plan to nurse for at least a year, night nursing will become the time you nurse most frequently, since older babies are so busy during the day nighttime becomes their prime time to nurse. Co-sleeping is the nursing Mom's survival tool.
  • Don't supplement with formula: Supplementing will harm your milk supply unless you pump to make up for the missed feeding. Breastfeeding is supply and demand and if you reduce the demand by feeding formula then the supply will also decrease.
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I'm not a lactation consultant and all of this advice is only from my own experience. These are the things that I did and the advice that I followed to make sure that breastfeeding got off to a good start and continued until my babies were one year old. As I said above, breastfeeding can certainly succeed even if you are unable to do many of the things that I have listed. If you require a c-section, there are things that you can do to make sure that the impact is lessened on your efforts to breastfeed. Try to go into labor naturally, this will ensure that your baby is ready to be born and will be fully developed. Go easy on the pain medications and avoid opiates at all costs. Talk to you doctor about which medications will have the least effects on you and the baby. Request that you do skin-to skin while they are finishing your surgery, attempt to nurse as soon as possible and nurse frequently. In other words, nurse early and nurse often. If you do have to send the baby to the nursery, request that they do not feed the baby sugar water or formula. If you are unable to nurse baby for the first time within the first few hours after birth, you should hand pump frequently to get things flowing. You will be in more pain and be less mobile than after a natural birth, but if breastfeeding is your priority then you can overcome the challenges that a c-section may cause.

For more advice on breastfeeding, please check out Annie's Breastfeeding Resource at Rookie Moms. She lists all the sites that I've found helpful, plus more. One of the sites listed, KellyMom, is run by an international board certified lactation consultant and it is the single best resource for nursing Moms.

(Disclaimer: This post has been edited to be more sensitive towards mothers who are unable, for medical or personal reasons, to breastfeed. Following the above recommendations are not a guarantee that breastfeeding will go smoothly. There are sometimes unforeseen circumstances and situations that don't allow mothers to meet their personal breastfeeding goals. In those cases, there are alternatives if you want to feed your baby breast milk, but can't (or don't want to) nurse at your breast. You can bottle feed pumped or donated milk. If those situations are also not an option, you can feed formula. Breastfeeding is not easy, it is not perfect and it is not for everyone, however, breastfeeding is the most natural way to feed your baby.)

Please check out these other fabulous posts in the carnival!

Tales from the Crib: On Not Being Discouraged

Mama Eve: Birth & Breastfeeding by Suchada

Massachusetts Friends of Midwives: Early Intervention Lactation Help by Christina

Baby Fingers: My Breastfeeding Relationships: Hospital vs Homebirth by Jenny

Mama Bear: The long, wide shadow of a bad birth by Michelle

Reproductive Rites: Fighting for Breastfeeding by Sarah

Motherwear Blog:The birth/breastfeding continuum by Tanya

Tumbling Boobs:Nursing after Surrogacy or Adoption by Kate

Chronicles of a Nursing Mom: Birth Experiences and Its Effect on Breastfeeding by Jenny